Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207U00000X | Nuclear Medicine Specialist | 62822 | MN |
NPI | 1265895551 |
---|---|
Provider Name | Timothy John Jaykel |
First Address | Rochester, MN 55905-0001 |
Second Address | Rochester, MN 55905-5429 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
62822 | (05) | MN |